Central Cord Syndrome
Central cord syndrome
Central cord syndrome is an "incomplete lesion," a condition in which only part of the spinal cord is affected. In central cord syndrome, there is greater weakness or outright paralysis of the upper extremities, as compared with the lower extremities. Unlike a complete lesion, that causes loss of all sensation and movement below the level of the injury, an incomplete lesion causes only a partial loss of sensation and movement.
Central cord syndrome specifically affects the central part of the spinal cord, also known as the "grey matter." The segment of spinal cord affected by central cord syndrome is the cervical segment, the part of the spinal cord that is encased within the first seven vertebrae, running from the base of the brain and into the neck. The central part of the cervical spinal cord is responsible for carrying information to and from the upper extremities and the brain, resulting in movement. Because the outer (peripheral) areas of the cervical spinal cord are spared, information going to and from the brain and the lower extremities is not as severely affected.
The specific degree of impairment depends on the severity of the injury. More mild impairment may result in problems with fine motor control of the hands, while more severe impairment may cause actual paralysis of the upper limbs. While the lower limbs are less severely affected in central cord syndrome, in more serious injuries the lower extremities may demonstrate some degree of weakness, loss of sensation, or discoordination. Loss of bladder control may be evident as well.
Central cord syndrome often strikes people who are already suffering from a degenerative spinal disease called spondylosis or spinal stenosis. In spondylosis, a progressive narrowing of the spinal canal puts increasing pressure on the spinal cord, resulting in damage and debilitation. Often, a fall or other injury that causes a person with spondylosis to extend his or her neck will cause the already-narrowed spinal canal to injure the spinal cord, resulting in central cord syndrome.
As with other types of spinal cord injuries, men are more frequently affected by central cord syndrome than women. Because central cord syndrome can result from either injury or as a sequelae to the spinal disease spondylosis, there are two age peaks for the condition: in younger individuals (secondary to trauma) or in older individuals (secondary to spondylosis).
Causes and symptoms
Any injury or condition that preferentially damages the central, gray matter of the cervical spinal cord can lead to central cord syndrome. The most common causes include complications of the progressive, degenerative spinal disease called spondylosis, as well as traumatic injury to the cervical spine, such as fractures or dislocations. Injuries to a cervical spine that is already abnormally narrow due to disease is a particularly common cause of central cord syndrome. Tumors or syringomyelia (a chronic disease involving abnormal accumulations of fluid within the spinal column) may also lead to central cord syndrome.
Individuals with central cord syndrome may first notice neck pain and shooting or burning pains in the arms and hands. Tingling, numbness, and weakness may also be evident. Fine motor control of the upper extremities may be significantly impaired. Sensation in the upper limbs may be dulled or completely lost. Sensation from the legs may be lost, as well, and the lower extremities may demonstrate some degree of weakness and impaired movement. Bladder control may be weakened or lost.
Diagnosis is usually accomplished through imaging of the cervical spine, with plain x rays, CT scans , and/or MRI imaging.
The treatment team for central cord syndrome will consist of a neurologist and a neurosurgeon, as well as multiple rehabilitation specialists, including physiatrists, physical therapists, and occupational therapists.
Usually, intravenous steroids are immediately administered to patients suspected of suffering from central cord syndrome, to decrease swelling and improve outcome. Surgery may be performed in certain cases, in order to stabilize the spine or in order to decompress the spinal cord.
Many patients will be able to rehabilitate their less-severely affected lower extremities and will continue walking, although sometimes with a permanently abnormal, stiff, spastic gait. Many individuals also regain some strength and function of their upper extremities. Upper extremity fine motor coordination, however, usually remains impaired.
Hammerstad, John P. "Strength and Reflexes." In Textbook of Clinical Neurology, edited by Christopher G. Goetz. Philadelphia: W. B. Saunders Company, 2003.
Mercier, Lonnie R. "Spinal Cord Compression." In Ferri's Clinical Advisor: Instant Diagnosis and Treatment, edited by Fred F. Ferri. St. Louis: Mosby, 2004.
Morris, Gabrielle, F., William R. Taylor, and Lawrence F. Marshall. "Spine and Spinal Cord Injury." In Cecil Textbook of Internal Medicine, edited by Lee Goldman, et al. Philadelphia: W. B. Saunders Company, 2000.
National Institute of Neurological Disorders and Stroke (NINDS). NINDS Central Cord Syndrome Information Page. November 6, 2002. (June 4, 2004). <http://www.ninds.nih.gov/health_and_medical/disorders/central_cord.htm>.
Rosalyn Carson-DeWitt, MD